Ruth plays his club hurling with the James Stephens club in Kilkenny and has enjoyed some success.
After developing his hurling at juvenile levels Ruth was drafted into the club's senior team as a seventeen-year-old in 2004. He was a non-playing substitute for James Stephens's county, Leinster and All-Ireland victories.
By 2005 Ruth had become a regular on the club's senior team. He missed the county final victory over Ballyhale Shamrocks because he was playing for the club's minor team in the opening game on county final day. The minors lost that game by two points. Ruth subsequently returned to the senior team, winning a Leinster club title following a 2-13 to 1-12 defeat of UCD.
Ruth appeared in two more county finals in 2008 and 2009, however, James Stephens were defeated by Ballyhale Shamrocks on both occasions.
Ruth first came to prominence on the inter-county scene as captain of the Kilkenny minor hurling team in 2004. That year he won a Leinster title following a 1-15 to 1-04 defeat of Dublin. Ruth's side were later defeated by Galway in an All-Ireland final replay.
Kilkenny failed to retain their provincial title in 2005 and Ruth's minor hurling career came to a close
Ruth did not make it onto the Kilkenny under-21 team straight away, however, by 2008 he was a key member of the team in 2008. That year he won a Leinster title following a 2-21 to 2-10 defeat of Offaly. Ruth later added an All-Ireland medal to his collection following a 2-13 to 0-15 defeat of Tipperary.
In 2011 Ruth made his senior debut for Kilkenny in the pre-season Walsh Cup tournament. He later lined out in various group stage games of the National Hurling League and started in the league final defeat by Dublin. Ruth subsequently made his championship debut when he came on as a substitute in the Leinster final defeat of Dublin. It was his first Leinster winners' medal.